Art of Medicine
Sep 2018


Audrey Gray, MD, MPH
AMA J Ethics. 2018;20(9):E894-896. doi: 10.1001/amajethics.2018.894.


This image seeks to iteratively represent themes related to the availability of life-saving and life-threatening medications. The photograph also suggests the importance of several ethical questions.


Figure. Kaleidoscope



Digital photograph.


This image seeks to iteratively represent themes related to the availability of life-saving and life-threatening medications. Today there are many medications available for previously deadly diseases, such as immunotherapy for cancer, dozens of HIV drugs, and ever more blood thinners for a host of cardiac issues. However, many of these drugs are out of reach for the average person. For example, medication for hepatitis C costs tens of thousands of dollars per patient.1 Treating hepatitis C can prevent deadly sequelae in the infected person and prevent spread of the infection to others, and there are public health benefits to society at large. But who shoulders the price of the drug? Most cannot afford such an expensive medication. All budgets are finite, though, so who decides which individuals get treatment? Which ethical guidelines should guide such decisions? Should drug companies be allowed to charge so much for this treatment?

Another ethical issue suggested by the photograph has to do with the abundance of potentially life-threatening medications, such as opiates. The US is in the midst of an opioid epidemic. More than 100 people died daily from opioid-related drug overdoses in 2016, and more than 11 million people misused prescribed opioids that year.2 How do we balance the needs of some patients in pain against the needs of those misusing opioids? We, as members of the medical profession, contributed to this crisis. How can we best serve addicted patients? In medicine, we do much more than just prescribe pills. Yet the ethical issues surrounding access to medications, or lack thereof, influence our prescribing practices.


  1. Gonzalez Gompf S. Hepatitis C cure: symptoms, transmission, treatments, and costs. MedicineNet. Accessed July 14, 2018.

  2. US Department of Health and Human Services. What is the US opioid epidemic? Reviewed March 6, 2018. Accessed July 14, 2018.


AMA J Ethics. 2018;20(9):E894-896.



Conflict of Interest Disclosure

The artist(s) had no conflicts of interest to disclose.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.